Wellness

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Introduction

This page is meant as a resource on Wellness for our department.Our personal and emotional well-being is a surprisingly vital part of every anesthetic.How we are feeling about our lives in general and our jobs in particular has an enormous impact on the care of our patients.Stress and burnout can lead to suboptimal patient care resulting in more malpractice claims, more errors, decreased patient compliance, increased patient recovery times, and decreased patient satisfaction.A complete lecture on clinician wellness can be found here: (coming soon).

Caregiver Support

Bad things happen in medicine whether due to errors or failures to prevent the inevitable.Being a part of these events can have lasting ill effects on our mental health.We often feel responsible for the outcome which leads to a sense of incompetency, isolation, burnout, and even PTSD.Albert Wu described clinicians that experience an adverse event as second victims.He advocates for a rapid deployment of help to not only prevent the psychological trauma, but also to prevent a Third Victim: the people we take care of after the disaster when we may not be psychologically available to provide our best care.

Our department has developed and is expanding a caregiver support team.At this stage, our focus is on the residents.We hope to expand it to the CRNAs and attendings as time progresses.We have set up a listserv that anyone can use if they have experienced an adverse event themselves or know of anyone that has.The email will be forwarded to the Chief Residents who will then contact the person involved to offer their support.The email address can be found here:

Please do not provide specific details of the incident by email. A general picture of the event will suffice. The goal is not to problem solve the medical issue but instead to deal with the psychological aftermath.

On a different but related note, sleep is important. Sleepiness and driving is like drinking and driving. There are plenty of stories of physicians falling asleep at the wheel after a call night.
The GME office will reimburse you if you decide to take a cab (or Uber) post-call.We highly recommend you use this service. The application is here:

Depression and the HEAR Program

Depression is significantly more common in physicians and nurses than the general population.Upwards of 30% of residents and junior attendings are depressed.Also more common is suicidal ideation (S/I).The prevalence of physician S/I is more than double the general population and is equivalent to soldiers returning from war with traumatic brain injury and PTSD.The second leading cause of death in medical students, residents, and junior doctors is suicide. UCSD has developed a program called Healer Education Assessment and Referral (HEAR) to help medical practitioners experiencing depression and/or S/I.They provide an online, anonymous screening questionnaire which they use to provide confidential feedback, referrals, and support.Their website can be found here:

Burnout and Mindful Meditation

Burnout is a syndrome of emotional depletion and withdrawal; depersonalization; and low sense of personal achievement.Personal consequences of burnout include a decreased ability to learn; increased depression and suicidal ideation; cynicism and anxiety; and physical diseases including cerebral and cardiovascular disease. Unfortunately burnout is more prevalent among physicians than the general population.A third of physicians and nurses are burned out.

Mindfulness is a method meditation in which the focus is a greater awareness of all thoughts, emotions, and sensations that the practitioner is experiencing at a given time.In other words, the focus is on the present moment.There is strong evidence that mindful meditation improves burnout.In addition, it has numerous positive effects on psychiatric disorders, general psychological health, general physical health, and even cardiovascular health.

The UCSD Center for Mindfulness has numerous classes on mindfulness.Although the idea of yet more training may not be appealing to many, the mindfulness courses - particularly the Mindfulness Based Stress Reduction one - are very effective.If you have the time, I highly recommend taking one. Their web site can be found here:

If you don’t have the time, there are online resources available that allow you to practice on your own time. The best that I have come across is Headspace. The training modules in Headspace are brief (10-20 minutes) and geared towards teaching the practicality and methodology of mindful meditation. Their web site can be found here:

Although I highly recommend mindful meditation, it may not be for everybody.(Please note, that invariably it takes a few weeks to months to get it to “stick”. So if you are giving it a try, do not look for results immediately.Keep at it!) Yoga (which in the Western world is a physical form of meditation) and Tai Chi have been shown to help in a similar manner. If you can overlook the cheesy salesmanship of the companies,
Corepower Yoga and
Yoga Six are great places to get started.